Provider Demographics
NPI:1386765485
Name:NACOGDOCHES CARDIAC IMAGING CENTER PLLC
Entity type:Organization
Organization Name:NACOGDOCHES CARDIAC IMAGING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:POKALA, M.D., F.A.C.C.
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:936-564-2637
Mailing Address - Street 1:1023 N MOUND ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4491
Mailing Address - Country:US
Mailing Address - Phone:936-564-2637
Mailing Address - Fax:
Practice Address - Street 1:1023 N MOUND ST
Practice Address - Street 2:SUITE L
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4491
Practice Address - Country:US
Practice Address - Phone:936-564-2637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR51043261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center